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Presentation

A 29-month-old female from Togo, a small country on the west coast of Africa, came to the Emergency Department after having emigrated to the United States approximately 2 weeks prior. The patient had been on anti-malarial treatment approximately 3 months prior to the emergency department visit.

Lab Testing

Based on the clinical presentation of the patient and the travel history (Togo, West Africa) serologies for various pathogens (Dengue, Yellow Fever, Rickettsia), blood cultures and malaria smears were ordered. Light microscopy of thick and thin Giemsa-stained blood smears remains the standard method for diagnosing malaria.

Cause of Symptoms

Even though this patient had been on prior prophylaxis for malaria, her smears showed the presence of Plasmodium sp., the causative agent of malaria. Most clinical laboratories attempt to speciate the Plasmodia based on the life cycle stages presents on the smear in the microbiology laboratory. The parasite replicates within the red blood cell of the infected host. However, no species identification was given in this particular case. If speciation is difficult, public health is contacted for assistance in identification of the parasite in the United States. Plasmodium sp. are transmitted through the bite of an infected mosquito. Left untreated, patients may develop severe complications and die. In 2017, an estimated 219 million cases of malaria occurred worldwide (435,000 people died). These deaths were mostly children in Africa. Approximately 1,500 case are reported in the U.S., with nearly all of the infections originating in other countries and diagnosed in returning travelers. The malarial life cycle is complex, consisting of a variety of life cycle stages. The sporozoite is the infecting stage that is injected into the human host when the mosquito takes a blood meal.

Treatment

Treatment can vary depending on the Plasmodium species and region where the infection originated. This patient was treated with Quinidine and Clindamycin for 2 days and then Malarone for 3 days and recovered.